How does this medication work? What will it do for me?

Clomipramine belongs to the class of medications known as tricyclic antidepressants. It is used to treat depression and obsessive-compulsive disorders (OCD). These disorders are related to imbalances of certain brain chemicals. This medication helps to re-establish balance to these chemicals. It may take several days to a few weeks to see a significant benefit.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Apo-Clomipramine is no longer being manufactured for sale in Canada. For brands that may still be available, search under clomipramine. This article is being kept available for reference purposes only. If you are using this medication, speak with your doctor or pharmacist for information about your treatment options.

How should I use this medication?

The recommended adult dose of clomipramine ranges from 25 mg to 200 mg daily in divided doses, or as a single dose at bedtime. The dose depends on individual circumstances, but is usually started low and increased gradually as required and as prescribed by the doctor. Clomipramine may be taken with or without food. Taking it with food may decrease the chance of stomach upset.

Children and adolescents (10 to 17 years old) usually begin with a dose of 25 mg daily, increasing the dose by 25 mg every 3 to 4 days as prescribed by the doctor.

When discontinuing the medication, the dosage should be reduced gradually to prevent withdrawal effects.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take clomipramine if you:

are allergic to clomipramine or any ingredients of the medication

have acute congestive heart failure

have certain blood disorders

have glaucoma

have kidney or liver damage

have recently had a heart attack

have taken a MAO inhibitor such as moclobemide or phenelzine within 14 days

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

appetite changes (increase or decrease)

constipation

dizziness

drowsiness

dryness of the mouth

headache

heartburn

hot flushes

loss of appetite

nausea

tiredness or weakness (mild)

tremor

visual changes

weight gain

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

confusion

decreased sexual ability or interest

dizziness when rising from a sitting or lying position

eye pain

fast or irregular heartbeat (pounding, racing, skipping)

nervousness or restlessness

problems with urinating

shakiness or trembling

skin rash

Stop taking the medication and seek immediate medical attention if any of the following occur:

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Contact lens wearers: People who wear contact lenses should be cautious, as clomipramine may decrease tear production in the eye, thereby increasing the chance of eye damage for those wearing contact lenses.

Dental effects: Lengthy treatment with clomipramine may lead to more dental cavities as a result of dry mouth. You should have regular dental checkups and practice good dental hygiene while taking this medication.

Drowsiness/reduced alertness: Since clomipramine may cause drowsiness, especially at the beginning of treatment, be careful when engaging in activities requiring mental alertness, judgment, and physical coordination such as driving or operating machinery.

Glaucoma: This medication may cause the symptoms of glaucoma (increased pressure in the eye) to become worse. If you have glaucoma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Report any changes in vision to your doctor as soon as possible while you are taking this medication.

Heart disease: People who are at risk of heart attack or stroke may be more likely to experience heart problems when taking clomipramine. If you have been told that you have an increased risk of heart attack or stroke, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Heart rhythm: Clomipramine can cause changes to the normal rhythm of the heart, including an irregular heartbeat called QT prolongation. QT prolongation can cause fainting, seizures, and sudden death. If you are at risk for heart rhythm problems (e.g., people with heart failure, angina, low potassium or magnesium levels), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Neuroleptic malignant syndrome (NMS): Clomipramine may contribute to a potentially fatal syndrome known as neuroleptic malignant syndrome (NMS), when it is taken in combination with certain other medications. If you notice the symptoms of NMS such as high fever, muscle stiffness, confusion or loss of consciousness, sweating, racing or irregular heartbeat, or fainting, get immediate medical attention.

Orthostatic hypotension (dizziness upon arising): Move slowly when rising from a sitting or lying down position, as clomipramine can cause sudden temporary low blood pressure resulting in dizziness.

Seizures: There have been occasional reports of seizures occurring with clomipramine. Seizures are more likely to occur when higher doses of this medication are taken. If you have a history of epilepsy or medical conditions that increase the risk of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Suicidal or agitated behaviour: People taking antidepressants such as clomipramine may feel agitated (restless, anxious, aggressive, emotional, trouble sleeping, and feeling not like themselves), or they may want to hurt themselves or others. If you notice any changes in mood, behaviours, thoughts, or feelings in yourself or someone who is taking this medication, contact a doctor immediately. Your doctor will monitor you closely for behaviour changes, especially at start of treatment or when your dose is increased or decreased.

Thyroid disease: People who have an overactive thyroid gland are at an increased risk of developing an irregular heartbeat while taking this medication. If you have been diagnosed as having an overactive thyroid, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Urinary problems: This medication may cause urinary retention (difficulty urinating). If you have urinary tract problems, these symptoms may become worse. Discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Withdrawal: Withdrawal symptoms such as dizziness, nausea, headache, and sleep disturbance have occurred when clomipramine is stopped suddenly. This is not a sign of addiction. Do not suddenly stop taking this medication. If you are supposed to stop taking this medication, contact your doctor, who will advise you on how to gradually reduce the dose.

Pregnancy: The safety of this medication for use by pregnant women has not been established. It should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking clomipramine, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding, or whether you should gradually withdraw the medication.

Children: Clomipramine has not been studied for use by people under 10 years of age, and specific recommendations for its use by this age group cannot be provided. The long-term effects of clomipramine on childhood growth and development have not been determined.

Seniors: Seniors may be more at risk of side effects from this medication and may need to take lower doses.

What other drugs could interact with this medication?

There may be an interaction between clomipramine and any of the following:

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

stop taking one of the medications,

change one of the medications to another,

change how you are taking one or both of the medications, or

leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than the ones listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.